The impact of HBV infection on heart transplantation

Abstract

Background: Hepatitis B virus (HBV) infection is endemic in Korea. Following increased number of heart transplantation, the problem associated with hepatitis B reactivation is becoming an important issue. We aimed to evaluate the functional significance of HBV infection on outcomes of heart transplantation. Method: We reviewed all medical records of overall national heart transplantation recipients and donors who had HBV hepatitis at the time of the transplantation from March 1994 to May 2013. We investigated the HBV serology status, HBV-DNA level of donors and recipients, liver function test, immunosuppressive agent and antiviral agent prescription and hepatitis morbidity and mortality. Results: 1) There were twelve HBsAg (+) recipients and six HBsAg (+) donors. Median duration of follow up was 1715 days (minimum 162 days to maximum 6553 days). 2) Nine HBsAg (+) recipients (75%), who continued antiviral treatment, have survived without any hepatic event. Reactivation of HBV developed in 3 recipients at a median duration of 238 days after transplantation. They died of fulminant hepatitis despite antiviral rescue therapy. 3) In contrast, six recipients with immunity to HBV before the transplantation, who had received heart from HBV (+) donors, have survived without any liver related event. Conclusions: HBV (+) recipients have the comparable perioperative results and long-term survival rates as HBV (-) recipient. However, absence or cessation of antiviral prophylaxis indiscriminately brought reactivation of HBV, rapidly progressed to hepatic failure and death. In contrast, HBV (+) heart transplanted to HBV immune recipients were maintained without hepatitis reactivation. 19 years of national experience strongly suggests that long-term antiviral prophylaxis is mandatory for HBV (+) recipients.